Ordered,
	That Mr. Speaker do issue his Warrant for the Clerk of the Crown to make out a new writ for the electing of a Member to serve in this present Parliament for the County Constituency of Henley in the room of Alexander Boris Johnson, Esquire, who since his election for the said County Constituency has accepted the Office of Steward or Bailiff of her Majesty's Manor of Northstead in the County of York .—[Mr. McLoughlin.]

Adam Holloway: From next year, Her Majesty's Revenue and Customs will be able to show up at someone's office or workplace, their accountants or their bank and demand information about them. Can the Chancellor outline what benefits there will be from those massively increased powers?

Alistair Darling: I am not aware of being routinely asked for advice on such matters. Of course, the Treasury, if asked by either the Home Office or Foreign Office for their comments, would be happy to give them.

Vernon Coaker: I beg to move,
	That this House has considered that matter of knife crime.
	This is a very important and opportune debate, and the whole House would agree that the murders of 15-year-old Arsema Dawit and anti-gun crime campaigner Pat Regan over the weekend are deeply tragic. My sympathies and those of everyone will be with their families and loved ones, as well as with those of all the other victims of crime. Looking around the Chamber, I see Members whose constituents have been affected by such crime.
	No doubt, we will rightly consider in the debate the impact of knife crime, particularly with respect to young people, but I promised the young people at the NCH children's charity event that I visited in Hackney this morning that I would say that we should start by saying again that not all young people carry knives and that the vast majority of young people in this country are decent, obey the law, work hard and are a credit to themselves and their families. It is important to make that clear in this context.

Philip Hollobone: The statistics that my hon. Friend has given about the number of young people who feel unsafe in their communities are shocking. I would be surprised if many of those arrested or prosecuted for being in possession of a knife were coming into contact with the police of other authorities for the first time. Are the troublemakers—the leaders of the pack—not being dealt with seriously enough, early enough, before they reach the stage at which they carry a knife in public?

Dawn Butler: This debate is very important. In my constituency knife crime has almost remained stable. In 1997, there were 202 knife crime incidents in London, and in 2007, there were 212. What has become more prevalent is that the victims and perpetrators are younger and younger. We have a problem, and we must realise that it is not just knives and guns that kill people—it is people who kill people, and we have to go to the roots of the problem.
	I thank the Minister for attending a packed Committee Room 14 this week. About 80 per cent. of the people in that room were young people, and I remember the Minister raising his eyebrows at talk of postcode wars. That phrase is probably unrecognisable to many of us, but it is a serious issue. Young people feel that they are not able to go into other postcode areas because they fear for their lives. The Government will not be able to resolve that issue; we have to connect with young people in order to eliminate that interpreted fear. There are also road codes, to which we will never be party; they are the code of the road, and unless people live on that road, they will never know what the code is.
	What the Government can do—and they have been successful in it—is give money to young people so that they can have events to resolve those issues. The youth opportunity fund and the youth capital fund, which has now been extended, have enabled young people in my constituency to hold street parties. Young people from all over were able to gather and party together, which eliminated some aspects of the postcode wars. We cannot just throw out legislation and the Government should not be criticised for the work that they are doing, because we have to recognise the effect that it is having on the ground.
	There is a lot more work to be done, but in the work that I have been doing with young people, they have come up with recommendations, some of which will be presented to the Minister next week. One of the issues is policing. As well as giving respect to the police, young people would like to be respected by them, and part of that respect is manifested in police accountability. I implore the Minister not to get carried away by the idea of taking away the accountability involved in stop-and-search. That was a fundamental part of the Stephen Lawrence report. It also came about after the sus laws were used, under which police would randomly stop black people in the streets, which resulted in the Brixton riots. We do not want to get to that stage again. Stop-and-search accountability is important, and the Flanagan report suggests the use of electronic devices to make data inputting easier; there is a trial at the moment. I spoke to some police officers in Brent who told me that they prefer to fill in paperwork themselves, rather than give it to a clerk, because of mistakes that might be made that will affect their case later on. It is important that the police are still given the opportunity to record and register that information themselves.

Vernon Coaker: I thank the hon. Gentleman for that—it now seems clear that I will indeed be coming back. The serious point, however, is that Select Committees perform an important role not only in holding Ministers to account, but in considering how we move public policy forward and looking at what is happening. We owe it to the people of this country, and particularly the young people, not to be complacent, but to see what more we can do. I am pleased that hon. Members in all parts of the House welcomed the Prime Minister's statement this morning about the expectation of prosecution of all those over the age of 16 charged with a possession offence.
	In the brief time left, let me try to pick out some common themes. In answer to the hon. Member for Hornchurch (James Brokenshire), who, to be fair, made some reasonable points, I point out that the number of homicides involving sharp instruments has varied from year to year, but there has not been an explosion in the number of such homicides. These are the figures for homicides by sharp instrument as the apparent method of killing in England and Wales, which can include screwdrivers and things other than knives: there were 201 in 1998-99, 213 in 2000-01, 265 in 2002-03, 242 in 2003-04, 250 in 2004-05, 219 in 2005-06 and 258 in 2006-07. It is important to put those statistics on the record, because there are variations from year to year. Of course, we would not want any of those murders to be committed and would rather the figure for each year was zero.
	Neighbourhood policing is crucial, and we have committed resources to local police forces. The hon. Gentleman said that he wanted to tell the police how to organise things in their areas, but he will find that his party supports local decision making, and he will have to find a way around that. As my right hon. Friend the Member for Leicester, East (Keith Vaz) pointed out, we have put resources into policing and seen huge increases in the numbers of police on our streets.
	My right hon. Friend the Member for Leicester, East, the Chairman of the Home Affairs Committee, made a very good and wide-ranging contribution. I want to pick out two things that he said. First, he mentioned the importance of voluntary organisations such as the From Boyhood to Manhood Foundation. As I was trying to say to the hon. Member for Hornchurch, voluntary and community and organisations are crucial if we are to solve the problem. They often have a better handle on the problem and a better way of getting to the people affected, as my hon. Friend the Member for Brent, South (Ms Butler) knows from the work that she has done. We need to work better with such organisations and fully consult young people.
	The proposals on 16 to 17-year-olds that the hon. Member for Carshalton and Wallington (Tom Brake) mentioned have the full support of the Association of Chief Police Officers and prosecutors. We are trying to roll out weapons awareness programmes and so on. I agree with the hon. Member for Colchester (Bob Russell) on the importance of knife crime and the need to recognise that it is far more prevalent. As important as gun crime is, we need to ensure that knife crime has the importance attached to it that it needs.
	In the few seconds that are left, let me again thank all hon. Members who have taken part in this debate. As a Government, we are absolutely determined to do all that we can to work with everyone to deal with the problem. It cannot be solved, as hon. Members in all parts of the House have said, just by enforcement. All of us need to work together—
	 It being one and a half hours after the commencement of the proceedings, the motion lapsed, without Question put, pursuant to the Temporary Standing Order (Topical debates).

Ivan Lewis: I do not agree. There are a number of ways in which we influence the quality of care that older people and others experience. One of them is inspection and regulation; the other is the commissioning decisions that are made by local authorities or the NHS. Frankly, they should not be commissioning with either poor providers or even, on occasion, those providers that can meet only minimum standards. World-class commissioning is about ensuring that we organise services from those care homes and day care and domiciliary care services that offer people a high standard of care.
	The other important element is to ensure that individuals and families feel sufficiently empowered to complain and raise concerns if they are not getting the care that they need. Communities also need to take responsibility for ensuring that we treat older people in a positive manner. That becomes even more important as more and more people remain within their own homes. It would not be appropriate to send inspectors and regulators into people's homes, but equally there is an argument for saying that there is a vulnerability and risk to consider that requires us to think differently about the relationship between the state, the family and the individual. We must not make the mistake of believing that the only way to protect older people in this context is through the inspection and regulatory framework, although it is incredibly important.
	We have also introduced free nursing care for the first time. I mentioned the deferred payment scheme. It was this Government in 1999 who introduced the first ever national carers strategy. Since then, we have given every local authority a specific annual carers grant to expand respite care and to give better information and better emotional support to carers. There was a period in this country when there was a denial in public policy terms of the contribution and role that carers make. The fact is that carers have distinct needs as opposed to the needs of the people for whom they care. Six years ago we also launched Valuing People, to ensure that people with learning disabilities have the same life chances that many other citizens take for granted, whether it be a home of their own, a job or the opportunity to have a decent quality of social leisure life.
	Last year, I introduced a new national framework for continuing care. There were concerns about a postcode lottery across the country whereby some primary care trusts were not accepting their responsibilities in terms of recognising that people have nursing care needs as opposed to social care needs. That national framework has begun to make a difference to people's ability to access continuing care funding.
	This Government introduced a specific grant to stimulate the use of telecare. One issue that does not get sufficient attention in the debate on social care is the potential of modern technology to support people to have a more independent high-quality life, particularly within their own homes. We are seeing across the country a significant expansion in the utilisation of telecare to support people, but we have a long way to go. It is important to encourage and stimulate innovation because we are still pretty weak in terms of innovative development of services and innovative approaches.
	We also introduced the General Social Care Council to register social workers who move on to domiciliary care agencies so that professional standards are maintained and monitored. Skills for Care ensures that we invest significant amounts in a difficult environment, which has a low-skilled, low-paid work force, to get people who work on the front line of care services to at least level 2 qualifications and beyond.
	There has been an improvement in integration between health services, local government and the voluntary sector in some communities, although we still have a long way to go in the terms of the so-called Berlin wall between health and local government. I hope that we will be able to make more significant and rapid progress in the future.
	Our White Paper "Our health, our care, our say: a new direction for community services", for the first time commits us to a vision of integrated personalised preventive services. We should not forget in the context of a debate about how we treat older people in our country that older people have been the major beneficiaries of the slashed waiting times and waiting lists for the national health service. That point is frequently not made. Older people used to be made to wait for years for the treatment of health conditions, such as hip replacements and cataract operations, that affect people's ability on a day-to-day basis to have a decent quality of life. I am proud that as a result of the decisions taken and the targets set the Government have been able slash waiting lists. We will achieve the historic objective by the end of this year of a maximum wait for most treatments of 18 weeks. We should not forget that the major users of the NHS are older people. They have benefited significantly in terms of their independence and health as a result of our policy and the investment that has come directly from the Government.
	There has been a major expansion of community-based mental health services. We all know that of course it was right to close those institutions down and to give people the chance to live dignified, decent lives within the community. Anyone who spent time as I did in those dreadful long-stay mental handicap hospitals, where people were shut away from society for 40 years, will know that it was the right thing to do. The Conservative party embarked on that programme when in government, and I pay tribute to it for that. The only problem was that the Conservatives did not transfer adequate resources specifically to people with mental health problems within the community, so many of them were left in vulnerable positions, not having proper and adequate support. I am proud of the fact that we have significantly expanded mental health services in the community, although we have a long way to go.
	With regard to the controversy about the new GP contract, one of the other benefits that does not often get referred to is the fact that for the first time we incentivised GPs to take responsibility for the management of long-term conditions. That is another major advance. We should bear in mind that an ageing society is not the only challenge that we face. A major challenge is the number of people who are living longer with long-term conditions developed earlier in life, when they are in their forties and fifties, and making GPs responsible for managing such conditions and taking them seriously is an important way of preventing those people from deteriorating further.
	This year's programme of reform and other activities is probably the busiest and the most significant for 20 years. Since April, the Putting People First transformation scheme has been delivered in every local authority area, supported by half a billion pounds of Government funding over three years. It focuses on a shift from the present system, which tends to support people only when they become very ill or very dependent, to a system based on prevention and early intervention. The aim is to offer decent information, advice and, where appropriate, advocacy to everyone, including people who fund their own care.
	One of the unintended consequences of the community care legislation of the early 1990s was that people who went to their local authority and said that they had assets or means of £21,000 were told "You're on your own: there is no help for you here". It is crucial for us to ensure that those people have access to high-quality information and advice on difficult decisions relating to care and support for themselves or family members.

Paul Burstow: I am grateful to the Minister for giving way, because I appreciate that he wants to conclude his remarks today. I just want to ask him whether the national dementia strategy will come with some indication of how resources will be redirected and what additional resources will be applied to deliver it. For example, if inappropriate medication were used less, resources could be unlocked to invest in the training of staff, so that they could provide the extra support necessary to deal with the challenging behaviour encountered in many care homes.

Paul Burstow: In his opening remarks, the hon. Gentleman was critical of the Government for publishing a consultation document that was long on analysis but short on prescription. Surely the way for him to start goading the Government into developing their policies is for the Conservative party to set out what it would do, but that is signally not what we have heard so far. Will the he tell us what the Conservative party thinks about such issues?

Jeremy Wright: Does the hon. Gentleman agree that one of the difficulties with charging is defining what is a social care need and what is a health care need? The Minister described a number of times the Berlin wall between health and social care. Is not the problem that sometimes some of the issues are being smuggled in or over the Berlin wall between those two, so that is what is really a health care need, which should be funded entirely by the state, is called a social care need, and the person receiving the care has to make a contribution?

Barbara Keeley: I have been involved in social care issues for some 13 years, first as a council executive member and later when researching health and social care issues with national carer charities. I believe that social care is in a more prominent position now than at any other time during those 13 years. Even during my time in the House, it has risen on the political agenda. The demographic changes that we have discussed today are a big reason for that, but the Government's commitment to the agenda is a key element as well.
	The Prime Minister has placed social care and carers high on the agenda, but I also commend the personal commitment of the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), who has won wide recognition among stakeholder organisations for the determined way in which he has driven social care issues to prominence. At a recent consultation event, he said that we should be judged by our actions and not our words in our commitment to social care. I look forward to seeing plenty of action to improve social care services in the coming months and years.
	As next week is carers week, I shall focus on carers in my speech. One of the aims of carers week is to reach out to hidden carers and ensure that they know where to find help and support. Once they have been identified, they can gain access to the services that are available to them. As a result of recent policy developments, the number of such services has increased. Carers are to receive pension credits in recognition of their caring work, more money has been allocated for emergency respite care, and new information and help services are planned. That support and recognition is crucial to carers, as all the consultations for the strategy review have shown. However, we cannot avoid the fact that we cannot support carers better until we identify them more thoroughly.
	In my constituency and across the country, there are to be many events to mark carers week. I congratulate all who do such work. One event, at St George's high school in Walkden, aims to raise awareness of the most vulnerable group—young carers. A study by the charity Barnardo's found that 91 per cent. of teachers feared that young carers were falling through the net, and about three quarters of them thought that pupils were hiding the reality of their circumstances from friends and teachers alike.
	The teachers felt that it should be the responsibility of GPs and families rather than schools to identify young carers, but I think it important that schools and local authority children's services take some responsibility for them. Teachers can develop an understanding of the burden felt by young carers, protect them from bullying, and support them if they fall behind in their work. I pay tribute to young carers projects such as the one run by the Princess Royal Trust Salford Carers Centre, which is working with St George's high school.
	On Friday next week I shall attend an event at Hope hospital, Salford, supporting the Salford carers centre's efforts to make contact with hidden carers. I attended the same event last year, when we handed information keys to people as they passed our stand. I was amazed to discover how little recognition there was among even hospital staff that their role in caring for family members meant that they were really carers themselves. I discussed that with one person who questioned whether she was a carer, and whether the information applied to her. Clearly, she was. Although the hospital has a carer support worker on its staff, the message had not reached the staff that help and support were available and that their own organisation was in a position to help them, for example, by allowing them time off to attend medical appointments with those whom they looked after.
	That is a typical example of the problems involved in this issue. As Members of Parliament, we state that there are 6 million carers, but we do not think about how many of them we are not reaching, helping and supporting. Those people think of themselves as daughters, sons, husbands and wives but not as carers, and even in political discourse the word "carer" is often used to describe paid care staff.
	I discovered recently that the problem is often even greater among black and ethnic minority communities. At a national conference of carers from those communities, it was emphasised that language and cultural differences increased their problems. One carer said that in his language there was no word to describe schizophrenia. He cared for a son with the condition, but he could not describe it to others in his own language.
	On two occasions I have introduced 10-minute Bills which would give health bodies a duty to identify carers and then require them to be referred to sources of help and support. Identification of carers should result from an holistic view of the patient and their family. Opposition Front Benchers have expressed a similar view—that we must move toward that more holistic approach. If the patient needs substantial care and support, GPs should be looking around and asking who is providing it and how they, as health care professionals, can support the person providing the care.
	The need for GPs to identify patients who are carers and patients who have a carer was first stated by the Government nine years ago, in the first national carers' strategy. The five-point checklist given to GPs in that strategy suggested, for example, that they check carers' physical and emotional health at least once a year, that they tell them that they can have an assessment, and that they help them to find local support groups or carers' centres. Clearly, that does happen—Members may be aware from their own surgeries of carers who know that such help is available—but even though my constituency has a wonderful carers centre, many of the people who come to me do not know about the help and care available to them.
	The GP contracts established in 2004 appeared to offer an ideal opportunity to ensure that GPs undertook the work of identifying carers, but out of a maximum of 1,050 "points" available in the contracts for the quality of GP services, only three relate to identifying carers. In my view, that gives insufficient incentive to GPs to undertake what is becoming a vital task. I hope that the updated carers strategy and developments based on it in the months and years to come will ensure that we take on the vital task of identifying carers, making it something that GPs must commit to contractually, rather than just optional. Because the contractual reward is so small, many GPs simply have not bothered with it. We talk about personalisation, but as there is very much more for a family and a carer to take on board, knowing at the right point of diagnosis where all the care and support can be found is vital.
	The "case for change" document asked which is more important: local flexibility or national consistency? It is crucial that we reach a consensus now on the balance between local decision making and ensuring a basic national entitlement to care. I believe that local decision making is important in many service areas, but, as other hon. Members have said, we have moved to a point where there are unacceptable differences between the level of social care services offered by local authorities and the continuing care services offered by various local NHS bodies.
	Let me give an example of decisions on the eligibility of patients for continuing care, which can be crucial. A constituent of mine, Mrs. Reade, desperately wanted to care for her husband at home when he was diagnosed as terminally ill with an aggressive form of motor neurone disease. His final weeks of life ran across Christmas and new year. The Ashton, Leigh and Wigan primary care trust turned down the request for continuing care because there were so many delays in reaching a decision, mainly caused by staff absences during the holiday weeks. The absence of a social worker in the hospital proved crucial to things going wrong there. Sadly, the letter conveying this decision to Mrs. Reade, which was written in very difficult, technical language, arrived just days after her husband had died in hospital. We can and must do better than that.
	Because I have two local authorities in my constituency, there is different provision for those of my constituents with moderate and substantial need; the services vary, depending on which council area they live in. I hope that the CSCI review of eligibility criteria helps to iron out those differences.
	Many speakers today have touched on the need to recognise that service development is being pursued at different rates. Telecare, which I see as vital, has been used to great effect in some regions of the UK, such as West Lothian, and in some authorities—Oldham has been mentioned—but other authorities are not pursuing the new technologies at the rate that they should. I am very pleased that the Department of Health has announced the piloting of telecare and the £31 million investment to ensure testing on a large scale, but following the pilot, it will not be acceptable if some areas are allowed to lag behind in providing services involving telecare. My belief is that we have to accept the principle that people are entitled to equal care wherever they live.
	In conclusion, I commend the progress made by the Government in developing support for carers and greater choice and flexibility, in recognising the need to regulate and develop skills in the social care work force, and in the recent and earlier developments in telecare. As we set out on a path towards that new care and support system, which I am sure all hon. Members want, I hope that we can embrace the two developments that I have discussed. First, we must ensure that GPs and primary care staff identify carers, because there is no way that they will obtain the advice and support they need if the primary care people do not do that. Secondly, we must ensure that local decision making does not get in the way of offering decent minimum standards of both social care and continuing care.

David Kidney: I want to add my praise to the Minister for the policies and spending programmes that he has been responsible for introducing as he described. I also praise him for bringing the Government to the position that they are in, with the beginning of the consultation that we have debated today.
	We are coming to the end of the welfare state mark 1, which was designed by William Beveridge. I have always been slightly curious about the life of William Beveridge because for all my childhood I lived in a house in Beveridge close in Stoke-on-Trent. I always wanted to know why the street was named after him. It is tremendously to the credit of our predecessors, the politicians of 1941, that, in the depth of a dangerous war when the survival of our democracy was in the balance, they appointed William Beveridge to design the state of Britain that we would hope for when the war was won. The welfare state that was then implemented by the 1945 Government—the national health service, social security and the philosophy of support for every citizen from cradle to grave—has stood us in good stead until now, but the faults and strains of 60 years of pressure have been well described.
	We have reached the stage where we need to design the welfare state mark 2, which must take account of the complex health and social care needs of many more older people than it did in the past. As my hon. Friend the Minister said, that involves an adult care system for many people other than old people; it is for all those who are disabled, those with learning difficulties, those with autism and carers.
	I am pleased that so many hon. Members mentioned young carers. Although we have been talking about adult care, youngsters often care for adult family members and we must ask to what extent the pressure is on them to provide that care because of failings in the social care system. As adults, we must ask what is our responsibility and why we deprive youngsters of their childhoods, as they take on those grown-up responsibilities of caring for adults.
	I hope that, in the consultation, we will design a system that can cope with all the new pressures and demands and be affordable. The Government are right to start with a fairly open consultation, with not very many constraints and restrictions, because there are big questions to answer about what we want in the system, how much it will cost and precisely what the public are prepared to pay through their taxes and through their personal expenditure from their own pockets, as they contribute to the debate during the six months of consultation.
	I want spend to the very short time that I have to contribute to the debate in describing an event that I jointly hosted at Stafford with Staffordshire university a few months ago, before the consultation began. We set ourselves the objective of contributing to the national debate, while anticipating changes in future national policy and starting immediately to implement them locally in Staffordshire. Our audience involved three Departments, the Association of British Insurers and other insurance representatives from the national scene. We had regional representation from the health, social care and voluntary sectors, as well as the main players from the local providers of health care, social care and voluntary services.
	We came up with five things that we thought it important to adopt in the policy. First, a conceptual change is required to assist an ageing society. We thought that universal provision must be taken as a prerequisite if we live in a fair and equitable society. Alongside that, we need a speedy integration of health and social care. It is important to invest in prevention as a high priority, echoing the King's Fund report "Paying the Price". We recognise that a significant debate is required on the balance between state responsibility, individual responsibility and family responsibility.
	The second thing was the future work force. We need a work force who are both flexible and fit for the future. Work force projection and planning require more sophistication for the future. Although we now see a slow movement from secondary to primary care health provision, the move of mental health services into primary care advances at a much slower pace.
	The third thing that we talked about was financing and communicating systemic change. A viable, fair and equitable system will cost more than the present one, but insurance alternatives need to be explored. A pooled finance system might help, by utilising state and individual components, and pass the equity test.
	The fourth thing was intergenerational support. How do we persuade young people to start to think about old age and to plan for later life? What are the incentives for them to do so? Although the dignity in care agenda has started work on valuing older people, much more is still to be done.
	The fifth thing that we wanted to talk about was the future focus of the system. Prevention must become a key priority alongside incentivising the health agenda, not the illness agenda. Technology needs the development that many hon. Members have commented on already today. They are the five points that we wanted to project. We want to move on to develop our services locally, anticipating what we think will be the national decision.
	Before concluding, I want to tell my hon. Friend the Minister that Staffordshire university was a great help to me. It has a centre for ageing and mental health, and it wants to contribute to the debate. I would offer its help, with its agreement, to my hon. Friend in any way that he wants, perhaps by hosting events, running panels to contribute to the debate and advising the Department of Health if it wants it. On the same basis, I want to offer my assistance, as a Member of Parliament, in the consultation, and suggest that other MPs want to do the same. We are a very good resource for collecting the views of our constituents, and for explaining to people that the consultation is taking place and how important it is. If necessary, we can host events ourselves to contribute to the debate over the next six months.
	There is so much more that I wanted to say, but there is not time to do so. I want to point out, as many people have done, the importance in any future care system of quality, the dignity of the individuals being cared for, and their protection from abuse. My last point takes the Minister on to a slightly different agenda. In the Queen's Speech in the autumn, there will probably be a Bill on equality. One of the burning issues is whether there will be a full-blown outlawing of age discrimination in the Bill. Given all that we have heard in today's debate, I urge the Minister to do his very best to make sure that the Bill outlaws age discrimination.

Paul Holmes: Like the previous speaker, I will cut short some of my comments, because we want to make sure that everybody can contribute before the end of the debate.
	I will be fairly brief on the funding issue, which has had quite a good airing. We have already established that provision of care in all areas is underfunded, and the situation will get a lot worse. We have an ageing population demographic, people are living longer as a result of more prosperity and better health services, and not only are more disabled people being born, but they are living quite long and fruitful lives when they would not have done so 30 or 40 years ago, due to the sort of policies and medical capabilities that there were in those days.
	Somewhere, someone will have to pay for the care that is needed. That can be done through general taxation, which is mutual insurance paid for according to ability, hopefully, although the Government's tax policies penalise the poor more than the wealthy. The other way is to follow the extreme USA example, in which the emphasis is on the individual being responsible. If the individual has not earned or saved very much, for whatever reason, that is tough. About five years ago, I was in Lincoln, Nebraska. Those of us visiting met a voluntary group that gave us a fantastic explanation of how it helped elderly people to access support, care and so on when they needed it. There came a point when we suddenly realised that all that it did was advise elderly people on how to spend whatever money, personal insurance or benefits they had got for themselves. There was no state aid, effectively. I hope that we do not move towards that extreme in the coming years.
	The Conservative and Labour Back-Bench spokesmen, but not my party's spokesman, have today suggested that we cannot possibly consider taxation. They say, "We will not put forward any suggestions involving that side of things, because that would cost money and upset voters." One way or another, we have to pay if we are to provide the decent society that various Members have talked about this afternoon. The money has to come from somewhere. It can come from a mix of taxation and payments. Otherwise, there are the extremes: it could all come from taxation, or we could take the USA approach, which leaves one in five Americans with no medical cover at all. When they reach old age or have a disability, it is even worse.
	We need to bite the bullet and be honest, especially given that we have only just reached the average level of western European taxation. We are not a highly taxed nation, contrary to what everybody on the street will tell you, if you ask them. I even read one analysis this morning suggesting that tax levels are lower than when the Conservative Government left office. I have checked the figures, so I know that we have just reached average levels of western European taxation. On health and education, which have had money poured into them, the average western European levels of investment has just been reached. We should not sell the pass completely and just say, "We are an incredibly highly taxed nation; we cannot afford to provide decent pensions, care, support and so on." However, I shall not go into huge detail on that point.
	Every MP has many examples brought to them by constituents. We have heard some today that illustrate the need for more and better targeted care services and care funding. One MP pointed out that he has two parents who are suffering from dementia. Many of us will have that experience in our families. Ten years ago, my father died with Alzheimer's. Last summer, my mother-in-law died with aggressive dementia as a result of multi-infarct. A few weeks ago, my mother died with Alzheimer's at 82. As so many others in the Chamber have done or will do, I have gone through all those problems that constituents bring us about ageing parents who physically need more help at home, and then start to lose their mental faculties. They may consider doing what we did: we moved my mother-in-law into our dining room and made it into a bedsit, and tried to cope in that way. As the dementia got worse, it became impossible. She needed 24-hour care. When one looks for care homes, all the issues of selling property, funding and payment arise. One way or another we will all go through that with members of our family, or ourselves, with our children going through it for us. The problem is widespread and we all have those experiences.
	There are further examples that constituents have brought to me. One of them is early onset Alzheimer's. Terry Pratchett, who was recently diagnosed with early onset Alzheimer's, is a famous example. One constituent came to me five years ago and the problem has still not been solved. Her husband in his early 40s was diagnosed with early onset Alzheimer's, which is quite rare at that age. As a result, no care home within decent travel distance was suitable. Although at 40 or 42 he had Alzheimer's, he knew when he looked around the care home full of old-age pensioners that there was something wrong—that was not his generation of people.
	My constituent's husband ended up in a care home some miles up the motorway, up past Rotherham, with his wife trying to travel back and forth every day to visit him. We had round table meetings with all the medical professionals and social services. We all agreed that it was an immense problem, and five years later we have still not solved it. That will become more common as we get better at diagnosing conditions such as early onset Alzheimer's.
	Respite care has been mentioned, so I will not go into detail about it. We can all think of constituents with autistic children. We have had examples of elderly people looking after elderly parents, where both sets are old-age pensioners. I can think of at least three sets of constituents where the old-age pensioner has been looking after a disabled child who is now an adult—pensioners who need care and respite themselves, but who have 30 or 40-year-old adult children living with them. One, for example, was born with mental disability and was blind, and is still living with his elderly pensioner mother. She is approaching 80 and he is 30 or 40-odd. Such cases are becoming more common and need support and funding.
	The entire year's budget for Derbyshire for disability adaptations to housing could be spent in the first three months of each financial year clearing the previous year's backlog. That would leave not a penny for anybody who applied for a disability adaptation to a house in the current year. That is an ongoing problem and I am sure it is not specific to Derbyshire. Other Members must have come across it as well.
	Some hon. Members have mentioned direct payments, usually with great enthusiasm. We all welcome direct payments. They are excellent in intent and in effect for the vast majority of people who access them. Some people want them to be spread into some areas of NHS funding and support, for example, but how good is the guidance and support given to people who access direct spending?
	What happens for people who access direct payment and become a small employer for the first time in their life, perhaps when they are a vulnerable adult? What will happen, for example, to a 73-year-old man who becomes blind virtually overnight, and at the age of 74 takes on direct payment and becomes a direct employer? First, he has carers through care agencies, but as one hon. Member commented, people do not like that. They have lots of different care workers coming in and they are never sure who is coming each day. In the example to which I refer, the man became a direct employer of one care worker, which worked well for a while.
	What happens if the person falls foul of employment law and ends up facing thousands of pounds of legal fees and compensation—about £20,000 in all, for a 79-year-old constituent who is blind? How do we avoid that happening? How widespread is that? I hope the Minister may be able to comment or write to me. I shall send him details of the constituent in question.
	Derbyshire country council might give me a substantive reply on the matter fairly soon. I wrote a month ago and asked some specific questions. I asked the council to provide me with hard copies of the documentation on being an employer that it provided to clients like my constituent five years ago, clearly indicating where it emphasised the legal obligations that direct payment would entail, and the guidance and training that it gave on the requirements of employment law. I understand that the situation was pretty chaotic five years ago and that Derbyshire county council undertook a massive rewrite of the procedures for that reason.
	In the council's latest newsletter to clients using direct payments, which came out only a few weeks ago, on 24 April, it said that it had a three-year-old manual that was prehistoric and needed rewriting because it was so out of date, and advised clients to take out employer and public liability insurance. Did it do that five years ago, four years ago or three years ago? How widespread is the problem? The Minister may know about that from cases that have reached his desk. I have asked colleagues, some of whom say that they have come across the problem. I will write to him with full details.
	Now that I have raised the issue in the House of Commons in a fairly gentle way, Derbyshire county council will give me a full, detailed and substantive response. If not, I shall seek an Adjournment debate to deal with the matter in rather more detail.

Ivan Lewis: With the leave of the House, Mr. Deputy Speaker, I should say that, on the whole, this has been an excellent, high-quality debate. However, I have to turn to the contribution from the hon. Member for Eddisbury (Mr. O'Brien), which demonstrated that Conservative Front Benchers have no policies, no vision and no substance when it comes to these and many other issues. I asked the hon. Gentleman how often the group set up by the Leader of the Opposition to consider social carers had met, and his answer was, "Many numerous times." Will the hon. Gentleman write and tell me how often it has met?
	Will the hon. Gentleman also speak to Sir Simon Milton about Putting People First, probably the most radical transformation of social care for a generation? It is happening in every local authority area. The hon. Gentleman described it as "a bundle of papers". I should tell him that there was never any commitment to a Green Paper specifically on individual budgets; later this year, we will publish the results of the evaluation into the individual budget pilots in the 13 local authority areas. The rest of the hon. Gentleman's contributions were very constructive.
	I can assure my hon. Friend the Member for Kingswood (Roger Berry) that there is a commitment to issue a Green Paper early next year. There is no doubt that as we consider fundamental reform of the system, we must take seriously the question of differential approaches to charging and, specifically, the portability of care packages. I pay tribute to his long-standing contribution to championing the rights of disabled people.
	On behalf of the Liberal Democrats, the hon. Member for Sutton and Cheam (Mr. Burstow) must answer the question about where the money for their policy would come from. Would it, as he hinted, come from cuts to spending elsewhere, such as in the NHS? Would there be a tax rise to fund it? He must also say whether their policy is genuinely sustainable in the long term or simply intended to get them through the next general election. I greatly respect the work that he has done on elder abuse and on dignity for older people, and I hope that he will think that the review of the No Secrets guidance comes up with an appropriate system for adult protection that reflects some of the tensions and challenges that have been evident in the debate.
	Everybody I have spoken to regards my hon. Friend the Member for South Thanet (Dr. Ladyman) as having been an excellent Minister for social care. He put in place the foundations that led to many of the reforms that have taken place in recent times. He is right that it would be wrong to talk about the future funding of social care being based on the existing system and model. The challenge is whether we can have a vision for the future that reflects people's changing aspirations, the opportunities presented by technology and extra care housing, and people's behaviour in terms of financial incentives. This is not simply about tinkering with the existing social care system.
	I pay tribute to the contribution by the right hon. Member for North-West Hampshire (Sir George Young). He clearly "gets it" in terms of self-directed support. It is one of the most radical reforms of public services—a redistribution of power between the state and the citizen the like of which has not been seen previously in public services. It is important that the policy is explained to people and that they are enthused by it, because it is an incredible example of social justice and equality of opportunity in action. He is right to point to the obstacles and barriers and to the lessons that we need to learn in putting into practice this entirely new approach to vulnerable people's rights to exercise self-determination and maximum control over their own lives.
	I pay tribute to my hon. Friend the Member for Worsley (Barbara Keeley), who has championed the cause of carers for many years since she entered this House. I hope that she will not be disappointed when she sees the new carers strategy on the role of GPs as regards identifying and acting specifically on the needs of carers. She is right to refer to the appropriate balance between universal entitlement and local discretion, which has come up time and again in the course of the debate.
	I pay tribute to the hon. Member for Rugby and Kenilworth (Jeremy Wright) for the work that he has done in the House on raising the profile of dementia. We have to bring dementia out of the shadows—that is one of our great challenges. He is right to prioritise the need for carers to have access to appropriate respite and to note that professionals sometimes do not treat carers with the respect that they deserve.
	I pay tribute to my hon. Friend the Member for Stafford (Mr. Kidney), who is right to say that many of these issues are at the frontier of the new welfare state—they are the new challenges to which any responsible Government, and indeed Opposition, should face up. He rightly identified five themes from the work that he has done with Staffordshire university.
	We did not speak enough about the work force. If we are to make a reality of this new agenda, it is essential to get the quality of the work force right. With a low-skilled, low-paid work force, we have a lot of work to do in thinking through the implications of the new system in terms of the people who will be required.
	The hon. Member for Chesterfield (Paul Holmes) said that Labour has poured loads of money into health and education. We do not often see that acknowledgement in "Focus" leaflets. He advocated significant tax hikes, although I am not sure that he will do so in his own constituency. However, he is right about guidance on issues such as direct payment.
	My hon. Friend the Member for North Durham (Mr. Jones) rightly talked about the nonsensicality of proposing the reorganisation and reconfiguration of services without being clear about the alternative provision that will be in place and the fact that that needs as far as possible to be available locally. There will always be a need for residential and nursing care, and sometimes acute hospital beds, for people with dementia. Decisions need to be made not just about the here and now, but with regard to planning for the long term needs of his constituents. I agree with him that there should be a genuine consultation but it must be about future provision and demand for people with dementia. It is important that the voice of relatives is heard in that debate.
	 It being Six o'clock, the motion lapsed without Question put.